Supervisor, Claims

Job SummaryThe supervisor provides direct oversight by supervising the day-to-day operations of all aspects of claims processing. This position provides training and coaching both on the group and individual levels, noting achievements and progress when completing individual performance evaluations as well as addressing taking disciplinary actions if necessary.Key Responsibilities/Duties - what you will be doingOversee day-to-day operations and the assignment and distribution of work to ensure that all claims are processed within the required time limits. Maintains the flow and processing of information within the Claims department to ensure turnaround times are achieved. Ensures that mandatory requirements, as set by regulatory bodies, are achieved.Establishes, builds, and maintains positive working relationships to ensure that all data is processed according to policy. Continually monitor reports and communication on regular basis.Participates in the development, implementation and improvement of departmental policies and procedures. Develops, monitors, and adjusts as necessary quality processes to provide performance measurement standards for individuals and the department.Provides feedback and coaching via regular one-on-one meetings. Conducts formal performance appraisals and appropriate disciplinary action in a timely manner as well as in accordance with NH Human Resources policies and procedures.Maintains a thorough understanding of claims processing. Conducts initial and ongoing education and training on Network Health policies/procedures and programs to ensure standardized approach to processing requests among team members. Updates staff on new developments in work processes and provider issues.Provides support to staff by researching, resolving, and collaborating with key stakeholders to solve complex and urgent issues. Ensures that appropriate person/department from across the organization is consulted on applicable issues.Manages and monitors of metric (software) to ensure adequate coverage and timely responses on an ongoing basis. Reviews and generate productivity reports on a weekly and monthly basis.Acts as the initial contact for the department for issues and delegates accordingly.Participates in departmental and interdepartmental meetings as appropriate and necessary.Participates in ad hoc projects, as necessary.Maintains professional growth and development through self-directed learning activities.Encourage a high work ethic within staff by demonstrating appropriate and acceptable management skills.Encourages and precipitates a collaborative work environment among team members.Other duties and projects as assignedQualifications - what you need to perform the jobAn in-depth understanding of Coordination of Benefits (COB) rules to ensure accurate coordination of benefits.Proficiency in handling Third Party Liability (TPL) claims and other Insurance policies including subrogation and recovery processes.Understanding of Federal, State, and industry-specific regulations and guidelines related to COB and TPL claims.A comprehensive understanding of healthcare, including HIPAA, Medicare, and Medicaid guidelines, in COB, MSP and TPL processesCompensation & Total Rewards OverviewAs part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:Medical, dental and vision coverageRetirement plansPaid time offEmployer-paid life and disability insurance with additional buy-up coverage optionsTuition programWell-being benefitsFull suite of benefits to support career development, individual & family health, and financial healthFor more details on our total rewards programs, visit We ArePoint32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.We enjoy the important work we do every day in service to our members, partners, colleagues and communities.Scam alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@.This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Created: 2025-03-01